Do Abstinence-Only Programs Delay the Initiation of Sex - ANEP

Do Abstinence-Only Programs Delay
the Initiation of Sex Among Young
People and Reduce Teen Pregnancy?
Douglas Kirby, Ph.D.
October 2002

This paper was developed with the assistance of the National Campaign to Prevent Teen Pregnancy’s Effective
Programs and Research Task Force (listed below). The conclusions are those of the author.
Chair
BRENT MILLER, PH.D.
Vice President for Research
Utah State University
Members
CHRISTINE BACHRACH, PH.D.
Chief, Demographic and Behavioral
Sciences Branch
National Institute of Child Health and Human
Development
VANESSA CULLINS, M.D., M.P.H., M.B.A.
Vice President of Medical Affairs
Planned Parenthood Federation of America
JACQUELINE E. DARROCH, PH.D.
Senior Vice President and Vice
President for Research
The Alan Guttmacher Institute
SAUL D. HOFFMAN, PH.D.
Professor, Department of Economics
University of Delaware
DANIEL T. LICHTER, PH.D.
Professor, Department of Sociology
Ohio State University
WILLIAM MARSIGLIO, PH.D.
Professor, Department of Sociology
University of Florida
REBECCA A. MAYNARD, PH.D.
University Trustee Chair Professor
University of Pennsylvania
JOE S. MCILHANEY, JR., M.D.
President
The Medical Institute for Sexual Health
RON B. MINCY, PH.D.
Maurice V. Russell Professor of Social Policy
and Social Work Practice
Columbia University, School of Social Work
SUSAN PHILLIBER, PH.D.
Senior Partner
Philliber Research Associates
MICHAEL RESNICK, PH.D.
Professor and Director
National Teen Pregnancy Prevention Research Center
University of Minnesota
FELICIA H. STEWART, M.D.
Adjunct Professor, Department of Obstetrics,
Gynecology and Reproductive Sciences
Co-Director, Center for Reproductive Health
Research & Policy
University of California
STAN WEED, PH.D.
Director
Institute for Research & Evaluation
The National Campaign to Prevent Teen Pregnancy is a nonprofit, nonpartisan organization
supported largely by private donations. The Campaign’s mission is to improve the well-being of children,
youth, and families by reducing teen pregnancy. Our goal is to reduce the rate of teen pregnancy
by one-third between 1996 and 2005.
Note to Reader: You may be interested in reading Dr. Kirby’s Emerging Answers: Research Findings on
Programs to Reduce Teen Pregnancy. The full report and summary are available at
www.teenpregnancy.org.
Suggested citation: Kirby, D. (2002). Do Abstinence-Only Programs Delay the Initiation of Sex
Among Young People and Reduce Teen Pregnancy? Washington, DC: National Campaign to Prevent
Teen Pregnancy.
Copyright © 2002 by the National Campaign to Prevent Teen Pregnancy. All rights reserved.

Introduction
In May of 2001, the National Campaign to Prevent Teen Pregnancy published a
thorough review of programs designed to delay the initiation of sex, increase condom or
contraceptive use, and reduce teen pregnancy. That review, Emerging Answers: Research
Findings on Programs to Reduce Teen Pregnancy, said at the time that "the evidence is not
conclusive about the impact of abstinence-only programs," and that "there do not currently
exist any abstinence-only programs with reasonably strong evidence that they actually delay
the initiation of sex or reduce its frequency." Emerging Answers also stated, however, that
based on the relatively meager evidence available, "one should not conclude that all
abstinence-only programs either do or do not delay sex." It suggested that some abstinenceonly
programs may be effective while others may not.
In April of 2002, Robert Rector, a Senior Research Fellow at the Heritage Foundation,
a Washington, DC-based think tank, published a paper titled, "The Effectiveness of
Abstinence Education Programs in Reducing Sexual Activity Among Youth." Its
conclusions were quite different from those of Emerging Answers, published a year before.
In particular, the Heritage paper said that "abstinence education programs for youth have
been proven to be effective in reducing early sexual activity," and the paper identified ten
studies it said demonstrated that abstinence-only programs can reduce sexual activity among
youth.
The Heritage Foundation review raises the very important question: Do there now
exist studies with good evidence demonstrating that one or more abstinence-only programs
actually delay sex and/or reduce teen pregnancy and have the findings about abstinence-only
programs presented in Emerging Answers become outdated? This review will address that
question by assessing the ten studies highlighted in the Heritage monograph.
Standards of Evidence
Before doing so, however, it is important to discuss standards of evidence. There are
a great many studies of programs, including abstinence-only programs and sex and HIV
education programs, that are designed to delay the initiation of sex, help sexually active youth
refrain from further sexual activity until they are older, and sometimes increase use of
condoms and contraceptives. Some of these studies are very well designed and can provide
strong evidence that a particular program either did or did not change sexual behavior. But,
unfortunately, many of the studies are not based on generally accepted standards of good
research, and therefore little can be learned from these studies about the impact of these
programs on actual behavior. Thus, it is important to first establish a set of standards − that
is, a set of criteria describing the characteristics a study must have in order for its results to be
regarded as scientifically valid evidence. After such standards have been established, then
studies meeting those standards should be identified and their evidence examined.
This is exactly what was done by the Effective Programs and Research Task Force
(EPR) of the National Campaign to Prevent Teen Pregnancy during the review of studies for
Emerging Answers. The Task Force first reached agreement on the criteria that would
determine whether or not a study provided sufficiently strong evidence to be included in the
review at all (pp. 115 in Emerging Answers). For example, the task force agreed that in
order for studies to be included in the review:
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• The study must have used an appropriate and valid experimental or quasiexperimental
design. For example, if the intervention targeted either individual youth
or classrooms of youth, then at a minimum the study must have used a quasiexperimental
design with both intervention and comparison groups and baseline and
follow-up data. If the intervention targeted entire schools or entire communities, then
at a minimum the study must have used a quasi-experimental design with school-wide
or community-wide time-series data, or alternatively a quasi-experimental design with
numerous intervention schools or communities and well-matched comparison schools
or communities with statistical adjustments for baseline differences, or another
appropriate and equally valid quasi-experimental design.
Studies employing experimental or quasi-experimental designs are very different from
those based on national surveys of youth. For example, studies based on national
surveys generally depend upon the respondents’ recall of whether they ever
participated in a particular type of program. They also have very poor measures of
the quality of any programs in which the participants were involved and may have
considerable difficulty controlling statistically for other factors that might produce
spurious statistical relationships or obscure actual relationships.
• Post-intervention data must have been collected for a minimum number of months
after the intervention. This minimum follow-up period varies with the design and the
behavioral outcomes of interest. When the study measured impact on the initiation of
sex, then it must have followed youth for at least six months after the intervention in
order to allow sufficient time for fewer youth in the intervention group than in the
comparison group to initiate sex. When the study measured impact on the frequency
of sex or use of condoms or contraception, then the study must have measured impact
for at least 2 months after the intervention or 4 months after baseline, whichever was
shorter.
• To qualify for inclusion in Emerging Answers, studies must also have had a sample
size of at least 100 and must have measured actual behavior (as opposed to attitudes
or intentions).
• Finally, the study must have employed proper statistical analyses.
After agreeing on the criteria, the EPR Task Force searched for and then assessed all
studies meeting these standards, regardless of whether or not they were published. Because
those criteria were thoughtfully developed and because the diverse members of the task force
agreed on them, they are also used here to examine the ten studies summarized in the
Heritage Foundation paper.
The EPR Task Force also developed a second much more rigorous set of standards. If a
study also met these standards, then it was identified as having especially strong evidence of
impact. That is, the task force and Emerging Answers used a two-tiered approach to
standards of evidence. Studies were included in the review and their results weighed if they
met basic standards of good research design. If, in addition, the study was particularly welldesigned,
its evidence of impact was considered to be especially strong. This same overall
approach is used to examine the ten studies summarized in the Heritage Foundation paper.
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Readers should note that the ten studies in question are discussed below in the same order as
they appear in the Heritage paper.
The Ten Studies Identified in the Heritage Foundation Paper as Effective Abstinence-
Only Programs
1. Virginity Pledge Programs. The first study examined the impact of taking a pledge to be
abstinent (Resnick, et al., 1997). That study provided some evidence that taking an
abstinence pledge was associated with later initiation of sex. Although the study was based
on a large national sample (the National Longitudinal Study of Adolescent Health), it did not
meet the criteria for Emerging Answers because it did not include a quasi-experimental
design. This is particularly noteworthy because of at least two factors. First, the analyses
relied upon young people's recall and report of whether or not they had taken a pledge and
some youth who took the pledge, particularly those for whom it was less meaningful, may
have been more likely to forget having taken the pledge. (A study of participation in a
different abstinence-only program revealed that many youth reported they had not
participated in the program when they actually had and vice versa.) Second, even before they
entered the program, youth who voluntarily took the pledge were likely to be different from
those who chose not to take the pledge, creating a “self-selection” bias. For example, pledgetakers
may have been much more likely to have pro-abstinence values and to intend to delay
sex than those who did not take the pledge. Without an equivalent comparison group, it is
not possible to determine whether the pledge, or adolescents' preexisting values, or something
else made the difference in sexual initiation.
2. Not Me, Not Now. The Not Me, Not Now program is a mass communications program to
promote abstinence through paid advertising on TV and radio, billboards, posters distributed
in schools, educational materials for parents, an interactive Web site, and educational
sessions in school and community settings (Doniger, et al., 2001). While some aspects of the
program reached many teens, the curriculum implemented in the schools (Postponing Sexual
Involvement) only reached about 3% of middle school-aged youth in the county where this
intervention was implemented and evaluated.
Because it is more difficult to evaluate the impact of community-wide campaigns, as
compared to curriculum-based programs, Emerging Answers had slightly less stringent
standards for including these types of programs; studies of this type were included without
comparison groups if they had multiple-time-series designs. The study of Not Me, Not Now
did include a time-series design and would have been included in Emerging Answers, if it had
been available sooner.
After the Not Me, Not Now campaign was initiated, the county-wide rates of sexual
activity among youth 15 and younger did decline (but those among youth 17 and younger did
not decline significantly), and the pregnancy rates among 15-17 year old teens declined faster
in the county than in similar upstate New York communities. Thus, the study produced some
evidence that the program delayed the initiation of sex and reduced teen pregnancy rates.
However, it cannot be known with any certainty that it was this particular program, rather
than other factors that caused the county-wide rates of sexual activity and pregnancy to
decline. In sum, these results are encouraging; they met the standards to be included in
Emerging Answers, but they did not meet the more demanding second set of Emerging
Answers standards for “strong evidence.”
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3. Operation Keepsake. This study did not meet the criteria for inclusion in Emerging
Answers, because it did not measure the impact on initiation of sex for at least six months; it
measured impact for only a very short period of time (14 weeks after the intervention)
(Borawski, et al., 2001). The effects of the program on the initiation of sex or on returning to
abstinence for two months, while positive, were not statistically significant. Although they
were very close to significance, the study failed to control for statistically significant
differences between the treatment and control groups in age, gender, and ethnicity. It is
unclear what the significance levels would have been if treatment-control group differences
had been statistically controlled. Thus, the short-term impact of this program on sexual
behavior is unknown.
4. Abstinence by Choice. This study did not meet the minimal criteria for Emerging
Answers because it had a very weak research design (Weed, 2001). In particular, it did not
have pre-intervention and post-intervention data from a comparison group of the same age.
5. Virginity Pledge Movement. Although this study thoughtfully and scientifically analyzed
the impact of taking a virginity pledge on subsequent sexual behavior and pregnancy, and
although it does provide some evidence that taking a pledge will, under certain conditions,
delay the initiation of sex, it did not meet the Emerging Answers criteria, because it did not
include an experimental or quasi-experimental design (Bearman & Brückner, 2001). Like the
first study above by Resnick and others, this study analyzed data from the National
Longitudinal Study of Adolescent Health − a national survey that did not have a quasiexperimental
design with independently known intervention and comparison groups nor did it
collect pre-intervention and post-intervention data. Rather, it had to rely on the memory of
youth participating in the survey and it had the many limitations of trying to statistically
control for the many factors that cause youth to take the pledge.
While the pledge appeared to delay onset of intercourse, it did so only under selected
circumstances. For example, it did not have a significant impact on girls younger than 14 or
older than 17; similarly it did not have a significant impact if no peers also pledged or if more
than 30% of peers pledged. And, if the youth who pledged did initiate sex, they were less
likely to use contraception. Thus, taking the pledge neither significantly decreased nor
increased the chances of pregnancy.
6. Teen Aid, Sex Respect, and Values and Choices. This study examined the impact of
three different abstinence-only programs, Teen Aid, Sex Respect, and Values and Choices
(Weed et al., 1992). It did meet the criteria for being included in Emerging Answers and was
included. As noted in Emerging Answers, the results indicated that among the group of high
school students with the most permissive sexual values, the programs did delay the initiation
of sex. However, the results also showed that 1) among all high school students, these
curricula did not significantly delay the initiation of sex, 2) among all junior high school
students, they did not significantly delay the initiation of sex, 3) among the two groups of
high school students with less permissive or least permissive sexual values, the programs did
not significantly delay the initiation of sex, and 4) among none of the three groups of junior
high school students did they significantly delay the initiation of sex. Thus, overall, these
programs did not significantly delay the initiation of sex, although in one out of six groups of
youth (the most permissive high school students), they appeared to significantly delay sexual
initiation.
7. Family Accountability Communicating Teen Sexuality (FACTS). The evaluation of
FACTS did not meet the standards of Emerging Answers, because of an inadequate evaluation
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design (Weed, undated). For example, the duration of time between the pre-intervention
surveys and the post-intervention surveys was not the same for treatment and comparison
groups, and baseline similarity of the intervention and comparison groups was not
established. This is particularly important because the families who volunteered to
participate in the FACTS programs were probably different from families who did not
volunteer. In addition, no tests of significance were provided.
8. Postponing Sexual Involvement (PSI). The study that measured the impact of PSI in
Atlanta, Georgia actually measured the impact of an “abstinence-plus” intervention that had
two components: PSI, which was abstinence only, and a second component which included
discussions of contraception (Howard & McCabe, 1990). This study did meet the standards
of Emerging Answers and was included. It provided some evidence that this particular
abstinence-plus program delayed the initiation of sex, but the evidence was not strong. It
should be noted parenthetically that when PSI was implemented in California as an
abstinence-only program (without the unit that included contraception), a rigorous evaluation
found that it did not delay the initiation of sex.
9. Project Taking Charge. The study of Project Taking Charge was not included in
Emerging Answers because of its small sample size (Jorgensen, Potts & Camp, 1993). It’s
also noteworthy that the measured impact upon the initiation of sex was not statistically
significant. Although the results were very close to significance, the test of significance did
not adjust for the fact that groups of students (as opposed to individual students) were
assigned to treatment and control groups. Failure to make this adjustment biases the
statistical results, and thus this study cannot determine the program's impact on initiation of
sex.
10. Teen Aid Family Life Education Project. The results and the summary presented in
this study are identical (except for a few words) to those presented in study number six above
(Weed, Prigmore & Tanas, 1992). That is, the same data were analyzed. This is not a
different study, but the same study already summarized above.
Summary/Conclusions
In sum, of the ten studies identified by the Heritage Foundation paper as providing
proof that their respective programs reduced early sexual activity, nine of them failed to
provide credible evidence, consistent with the standards of Emerging Answers, that they
delayed the initiation of sex or reduced the frequency of sex.
One of the studies suggests that the program, Not Me, Not Now, may have delayed the
initiation of sex among youth 15 and younger, but not among those 17 and younger.
Furthermore, it may have reduced county-wide pregnancy rates for youth aged 15-17. These
are encouraging findings, but it cannot be determined with any certainty that the declines
over time in these county-wide rates were caused by the abstinence-only mass
communications campaign, as opposed to other programs, influences, or changes in the
county. Nevertheless, people who want to implement large mass communication abstinence
campaigns should seriously consider putting this program in place, because among
abstinence-only programs, it has the strongest evidence to date that it may delay the initiation
of sex among younger teens and even reduce teen pregnancy.
It is also the case that taking an abstinence pledge might delay the initiation of sex
among some groups of youth and under certain conditions; it might also decrease their use of
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contraception when they do have sex. In addition, the Teen Aid program might delay the
initiation of sex among high school students with the most permissive values. However, the
evidence for these findings is not strong.
While the results of all of these selected studies of abstinence-only programs are
somewhat encouraging, it should be fully realized that these studies are not representative of
all studies of abstinence-only programs. That is, these studies were carefully selected from a
much larger number of studies precisely because they have encouraging results. Other
studies have less encouraging results and some even have negative results.
Thus, the major conclusions that can be reached at present are similar to those in
Emerging Answers: There do not currently exist any abstinence-only programs with strong
evidence that they either delay sex or reduce teen pregnancy. However, this does not mean
that abstinence-only programs are not effective, nor does it mean that they are effective. It
simply means that given the great diversity of abstinence-only programs combined with very
few rigorous studies of their impact, there is simply too little evidence to know whether
abstinence-only programs delay the initiation of sex. That is, “the jury is still out.”
Increasingly it seems likely to this author that sooner or later studies will produce strong
evidence that some abstinence-only programs are effective at delaying sex and that others are
not. However, until needed research is completed, we won't know which programs delay the
initiation of sex nor will we know whether they affect contraceptive use and teen pregnancy.
These conclusions are in contrast to studies of “abstinence-plus” programs that
strongly encourage youth to be abstinent because abstinence is the first and best choice for
teens, but also encourage youth to use condoms and contraceptives if they do have sex.
Many studies with very strong research designs have demonstrated that specific programs, as
well as groups of programs with common characteristics, can delay sexual intercourse, reduce
its frequency, increase condom use and/or increase contraceptive use. And, of course, these
behaviors are linked to reducing adolescent pregnancy as well as sexually transmitted
diseases.
There are many good reasons to encourage teens to delay sex, and encouraging
abstinence among young people is supported by overwhelming majorities of both adults and
teens nationwide (National Campaign to Prevent Teen Pregnancy, 2001). Therefore, it
remains very important to continue to evaluate rigorously the effectiveness of programs that
focus on this particular goal and to determine which programs are effective and which are
not. People concerned about this topic should look forward to additional studies of
abstinence-only programs, including the rigorous evaluation currently underway of selected
Title V abstinence education programs by Mathematica Policy Research.
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References
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Epidemiology and Biostatistics, Case Western Reserve University.
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